The Centers for Medicare and Medicaid Services (CMS) will delay the rollout of its Ambulatory Surgery Center (ASC) prior authorization (PA) demonstration project until early 2026. Originally scheduled to begin in 10 states on December 15, 2025, the 5-year initiative will require ASCs to obtain prior authorization from Medicare Part B carriers for select procedures, including blepharoplasty, blepharoptosis repair, brow ptosis repair, and botulinum toxin injection.

“We are pleased that CMS is delaying the implementation of the prior authorization program,” said Michael A. Romansky, JD, lead counsel for the Outpatient Ophthalmic Surgery Society (OOSS). “That said, we continue to strongly believe that prior authorization is not an appropriate responsibility for the ASC.”

OOSS, the American Academy of Ophthalmology (AAO), and other professional groups have raised significant concerns about the program. In 2024, they jointly urged CMS to halt implementation, noting that CMS’s hospital outpatient department PA program should be evaluated and improved before extending PA to surgery centers. They also requested that ophthalmic procedures—including blepharoplasty, brow ptosis repair, and botulinum toxin injections—be removed from the ASC PA demonstration. Stakeholders argued that CMS underestimates the administrative burden, overlooks risks of treatment delays, and fails to address potential patient access issues. Additionally, they emphasized that ASCs typically do not hold the patient records required for PA and recommended CMS clarify that the responsibility for obtaining authorization rests with the treating practice, not the surgery center.

ASCs in Arizona, California, Florida, Georgia, Maryland, New York, Ohio, Pennsylvania, Tennessee, and Texas are scheduled to be subject to the program. CMS revised the implementation timeline this week. Providers in California, Florida, Tennessee, Pennsylvania, Maryland, Georgia, and New York may submit PA requests beginning January 5, 2026, for dates of service on or after January 19. Providers in Texas, Arizona, and Ohio may submit requests beginning February 2 for services on or after February 16.